"There is a surprising degree of overlap between the kinds of questions a psychiatrist asks and those asked by a chaplain."
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At first, when I received calls to see patients in lock-down dementia units or patients on the psychiatry floor, I felt profoundly ill-equipped to address their needs. There seemed to be a line drawn by the diagnosis of mental illness beyond which I, as a chaplain, could not go. Over the course of my residency, I have come to realize that chaplains are not helpless in the face of mental distress, but can ease and transform psychological pain. Spiritual care-giving endeavors to bring a person some measure of wholeness of identity. I understand the chief task of chaplaincy to be facilitating the recovery of personhood in the face of illness. One theory of mental illness is that the greatest need of a person who is mentally ill is likewise a need for wholeness and integration. Thus, I perceive a great compatibility between the goal of chaplaincy and the needs of mentally ill patients. Moreover, a guiding principle of chaplaincy is that the patient presents the cues that guide the chaplain’s decisions about how to proceed during a visit. This patient-centered approach, while not exclusive to chaplaincy, can be a balm to the unmet need for basic recognition and acceptance that people with mental illness often experience.One primary tool of chaplaincy is reflective listening. This act involves hearing the emotional content that lies behind the words of patients and sounding this back to them. Reflection does not involve simply repeating words; it is a matter of reaching the feelings that underlie phrases expressed by the patient and making these feelings transparent to the patient. The act of reflecting a patient’s feelings back to him functions on the premise that attention is an integrating factor for personality development. The experience of any patient is rife with dis-integrating elements. A person’s experience of reality can shift dramatically in the space of a few seconds due to medical news, and destabilization of identity (and hence, mental health) can quickly set in unless there is a forum for the person to give voice to that identity.
Chaplains thus begin with feelings. All of the emotions of anger, fear, and sadness are for me, as a chaplain, clues that allow me to do my work. However, it is not always easy to access emotions, even as a person experiences intense psychological disarmament because of his illness. As a chaplain I ask questions that will enable the patient to articulate a picture of his or her inner state. It is my task not only to read the human document, but also to help the patient make sense of an illness. My responsibility is to read the emotional subtext of a patient’s story in order to find the missing pages, to then determine relevant sources of meaning, and, finally, to facilitate the patient’s ability to understand the missing pages in light of their sources of meaning. All are acts undertaken in an attempt to reestablish integration and a sense of personhood within the patient.
Patients often respond to the inner chaos engendered by bad news by retreating to the head to find a causal explanation for such chaos. Chaplains facilitate patients’ reconnection with their hearts and help them to move away from assessments that arise from sudden “head” reactions to their situation. We attempt to address the need to find meaning in the midst of pain by offering presence and solidarity to the one suffering, creating a space in which a person can live with and through suffering, rather than escape it by drawing causal connections that involve self-judgment, the judgment of others, or the judgment of God. In chaplaincy, this is known as the ministry of presence.
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